Provider Demographics
NPI:1255848842
Name:ANDERSON, KRISTIE M
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4735 SEQUATCHIE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SEQUATCHIE
Mailing Address - State:TN
Mailing Address - Zip Code:37374-7069
Mailing Address - Country:US
Mailing Address - Phone:931-327-5276
Mailing Address - Fax:931-463-9008
Practice Address - Street 1:1045 W MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:MONTEAGLE
Practice Address - State:TN
Practice Address - Zip Code:37356-7032
Practice Address - Country:US
Practice Address - Phone:931-327-5276
Practice Address - Fax:319-463-9008
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-04
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9319247823OtherPHONE NUMBER